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Post by crescentcitygal on Jul 31, 2007 23:01:30 GMT -5
Hi, everyone. I would like to hear from anyone who has experience with Catapres (Clonodine). My 6 yo DS (ADHD-combined type) was just prescribed this yesterday (patch form)by our new psych. He prescribed this for him because of the side effects stimulants have caused (we tried several, and while they did control his symptoms, all caused undesireable side effects).
I understand that this drug is being used to help with impulsivity in kids with ADHD (as well as aggression and tics). Although our son has the combined type of ADHD, I would say that impulsivity is the issue that causes him the most problems at school, and is what is threatening his participation in "mainstream" activities, so we are willing to try it. I have not found any information regarding how long it takes for this drug to start working, or how long for the full effect to be realized. Does anyone know, or can anyone tell me of their experiences with this? I certainly did not see the immediate improvement that we did with the stimulants. In fact, I haven't seen much improvement in his impulsivity or acting out in anger/frustration at all, although it has definitely made him tired (he took a nap today for the first time in months).
Should I expect it to take longer to see benefits with this drug? Also, does the sedating effect lessen with time? I wonder if his fatigue is causing him to be cranky, and therefore any calming effect is being "cancelled out" (my son does tend to get very cranky and misbehave more when he is tired).
Just wondering what to expect over the next few days/weeks with this medication. Thanks for any help or advice.
Paula
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Post by swmom on Aug 1, 2007 5:22:02 GMT -5
Paula -
We've been on Clonidine for over a year with much success. It has helped dd's impulsivity much more than any other med we've tried(stims - Concerta and Adderall, antidepressants - Paxil and Lexapro, and now Strattera. Dd is 13, already weighs 116, and is only on .15 mg. of the Clonidine daily so as you can see a little bit goes a long way! As far as how long it takes to work, for her it was immediate(within a day or two) but she's a fast metabolizer. I don't think most children metabolize meds like she does.
Re: the sleepiness. The first dose we tried was 1 mg. It knocked her out for the entire morning. She slept for FIVE HOURS, right after getting up. So, we realized she was on way too much. We finally found - through trial and error - that she only needed .1 mg/daily. Even on .1mg/daily, she tends to nap much more often than she used to. We're not sure yet if the meds are causing that or not. She's also on Prozac, which is an activating antidepressant so the doc thinks that may the culprit instead of the Clonidine. We also take Strattera, which has been, the best ADHD med for us. The stimulants ended her appetite, caused her to be very intense and angry, even though they worked well.
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Post by crescentcitygal on Aug 1, 2007 13:54:49 GMT -5
Thank you for your post, swmom. My son is using the skin patch form, which I believe delivers the equivalent of .1 mg/day. He seems even a little bit more tired today than yesterday.
I know this medication is supposed to help with impulsivity and angry outbursts (which are his main problems at school) more than inattention, and I can see that it definitely is NOT helping with the inattention. In fact, he didn't want to participate much at speech therapy or swim class today (probably because of being so tired). He seems slow and sluggish overall, and I have been needing to repeat things more than usual to get him to comply. I'm wondering if he would need a combination of meds to attack both parts of the problem. Is that why your DD is on Strattera as well as the Clonidine? We have not tried Strattera.
The dr. wants to see us in a week, so I guess we will stick it out at least until then. I really hope I start seeing less fatigue and a little more benefit because I really want this med to work so that my poor son isn't being constantly fussed at in school and at home.
Paula
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Post by swmom on Aug 1, 2007 16:15:02 GMT -5
Paula -
Dd is on Strattera for the ADHD. It also helps with anxiety and ocd symptoms. She's on Prozac for ocd and mood. Clonidine for impulsivity. This combination has been the best yet. We may need to adjust the doses from time to time, especially the Strattera(as she gains weight) and the Prozac.
What are your child's diagnoses?
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Post by crescentcitygal on Aug 2, 2007 15:15:58 GMT -5
swmom,
My son's diagnoses are mixed receptive/expressive language disorder and ADHD (combined type). He also has some behavioral traits that could place him on the milder end of the autism spectrum, but he does not have that diagnosis.
He has been very cranky today on the Clonidine (3rd day). He woke up very upset because he didn't get to say goodbye to daddy before he left for work. He cried about that on and off all morning, and he has been getting very emotional over little things. I thought the Clonidine would sort of "even out" his reactions to things, so I'm surprised at how emotional he has been today. On the other hand, I wonder if he's acting like this because of extreme fatigue. The Clonidine is definitely making him tired. On top of that, I was out late last night shopping for school supplies, and DH got the kids to be much later than their normal bedtime. Lack of sleep definitely makes him irritable, so I wonder if this is what I'm seeing...fatigue from Clonidine + not enough sleep. I don't want to give up on this medication too soon, but if I don't start seeing some positive effects soon, I'm going to have to stop.
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Post by swmom on Aug 3, 2007 5:38:39 GMT -5
Paula -
It sounds like your son might be on too much Clonidine. He's only six and he's on just about the same amount as my 116-lb. 13-year-old.
Dd has some language issues, too. Hers are primarily language processing though, specificially auditory processing. It is my understanding that kids with processing disorders tend to tire easily, just trying to constantly grasp what's going on around them. It's a daily struggle. We see that in dd. She has always tired more easily than others. We though initially that that was why she was cranky alot. In fact, she used to wake up in the morning tired and then yawn all day long. We couldn't figure out why she wasn't getting a good night's sleep. Then, we did a sleep study and discovered that she had sleep apnea. We took her tonsills/adenoids out. Big difference. Helped alot. No more yawning. HOwever, the irritability continued. Couldn't figure out why she was so cranky all the time, overreacted to everything. Everything was a big deal. Then, a psychologist told us that she was anxious, very anxious, like an 8 out of 10, all the time, possibly because of her constant processing struggles. Her next psychologist said she had obsessive compulsive disorder, which comes under the anxiety umbrella, and could possibly have come up as a way of compensating for the processing problem(not completely sure about that). Anyway, it became apparent that we needed to treat the ocd somehow. Prozac has helped a great deal with that. It has relaxed her, calmed her down, released her from the thoughts that kept getting recycled and recycled in her head. Two wonderful things we saw after beginning the Prozac were: she was much happier, not so irritable/worried. And, both her expressive and receptive language skills improved markedly. Never realized how much ANXIETY could impact LANGUAGE SKILLS.
What types of behavioral things are you seeing that makes you think your son is on the spectrum? Dd has some of those traits, too.
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Post by swmom on Aug 3, 2007 5:39:28 GMT -5
Paula -
It sounds like your son might be on too much Clonidine. He's only six and he's on just about the same amount as my 116-lb. 13-year-old.
Dd has some language issues, too. Hers are primarily language processing though, specificially auditory processing. It is my understanding that kids with processing disorders tend to tire easily, just trying to constantly grasp what's going on around them. It's a daily struggle. We see that in dd. She has always tired more easily than others. We though initially that that was why she was cranky alot. In fact, she used to wake up in the morning tired and then yawn all day long. We couldn't figure out why she wasn't getting a good night's sleep. Then, we did a sleep study and discovered that she had sleep apnea. We took her tonsills/adenoids out. Big difference. Helped alot. No more yawning. HOwever, the irritability continued. Couldn't figure out why she was so cranky all the time, overreacted to everything. Everything was a big deal. Then, a psychologist told us that she was anxious, very anxious, like an 8 out of 10, all the time, possibly because of her constant processing struggles. Her next psychologist said she had obsessive compulsive disorder, which comes under the anxiety umbrella, and could possibly have come up as a way of compensating for the processing problem(not completely sure about that). Anyway, it became apparent that we needed to treat the ocd somehow. Prozac has helped a great deal with that. It has relaxed her, calmed her down, released her from the thoughts that kept getting recycled and recycled in her head. Two wonderful things we saw after beginning the Prozac were: she was much happier, not so irritable/worried. And, both her expressive and receptive language skills improved markedly. Never realized how much ANXIETY could impact LANGUAGE SKILLS.
What types of behavioral things are you seeing that makes you think your son is on the spectrum? Dd has some of those traits, too.
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Post by crescentcitygal on Aug 3, 2007 10:51:17 GMT -5
swmom,
About the ASD-like traits: DS has some behaviors that could be considered mildly perseverative. I always thought they were more attention-related (like being distracted by some extraneous stimuli and being unable to follow through with the task at hand), but some who have worked with him thought some of the distractibility was more perseverative in nature (I'm referring mostly to visual distractions here).
We never thought DS had sensory issues, but now believe he probably does. One of his kindergarten teachers last year pointed out that he seems to crave lots of rough play and "deep pressure stimulation." She suggested this may be ONE of the reasons for some of his hyperactivity in the classroom, and some other behaviors like pushing, running and bumping into other kids on purpose, and pulling little girls' hair. This behavior never existed outside the classroom, but now it is starting to appear in other settings, like at home and in private speech therapy. His private SLP suggested an OT evaluation, which we just had, and the OT does agree that he could benefit from a little OT. I never considered sensory integration problems to be an issue before because he never had the most commonly-mentioned red flags like tactile defensiveness, picky eating, fine motor deficits, etc. So this will be a new area for us to explore.
Different professionals who have seen DS have said different things. Some said no PDD, some said that yes he does fit the criteria for mild PDD. So I guess I would describe him as either having a severe language disorder and ADHD with some other associated issues, or on the mild end of the spectrum. In either case, we are just committed to identifying his individual areas of need and getting him help for those specific needs.
DS has processing issues also, like your DD. We have also suspected auditory processing disorder, and were told that an evaluation for this is not really accurate until at least age 7 or so. He's coming up on that age, so we will probably have him tested soon. I think the treatment plan would be very similar to what we're already doing for mixed r/e language disorder, though. Have you tried any kind of auditory integration therapy, or listening therapy? The OT we saw is recommending something like this for him. As DS's language develops, he continues to have problems with pragmatics and using social language easily, another ASD-like characteristic.
Interesting to hear that your DD's language improved when the anxiety was addressed. We had long wondered whether the poor language skills were causing the ADHD behaviors, or whether ADHD was preventing him from learning language more quickly. When he was on stimulant medication, we did see an improvement in his language as well as the ADHD symptoms. Unfortunately, we had to take him off the stimulants because of side-effects. The previous psych. we had seen recommended Risperdal (then Abilify when the Risperdal sedated him too much). We tried it for a while, and it did seem to help his behavior in the classroom, but we took him off because of our concerns over the long-term effects of having him on antipsychotics at such a young age. This is was brought us to the new psych. and the Clonidine.
This morning, DD woke up happy and refreshed. We'll see how today goes.
Paula
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Post by zachsmom on Aug 6, 2007 11:02:36 GMT -5
Crescentcitygal,
Your ds behaviors sound very similar to my ds at that age. We tried Tenex at that age which is supposed to be less sedating with similar effects as the Clonidine. It too made him more irritable because he was too tired. He could not tolerate it at that age, but now at age 11 he can tolerate the Tenex 1 mg 2X/day. Stimulants could balance out the tired feeling he is experiencing (please see my post under the Daytrana Patch thread). My son also was on AP's and this so far has been the best combo, but we have not started school yet. I am anxiously awaiting the extended release Tenex. Strattera can also be very sedating (he has been on that also). Can you cut the patch of Clonidine in half and work back up if needed? He should probably get over some of the sleepiness over time, but you should probably start seeing results within a few days. Sleepiness can definitely make them worse.
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Post by crescentcitygal on Aug 6, 2007 12:35:43 GMT -5
zachsmom,
Thanks for your reply. Yes, I have considered cutting the patch in half. We go back to the psych. tomorrow for a follow-up, so I think I will wait to talk to him before changing anything. Did you find any combination of meds that worked for him when he was younger since he could not tolerate the Tenexat that age?
Paula
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Post by zachsmom on Aug 6, 2007 13:42:26 GMT -5
The only thing that seemed to help at that age was concerta, but he had lots of rebound when it wore off. We started Abilify when he was in 3rd grade and that reallly helped him, but he had toileting/soiling problems when he started it and they stopped when he stopped the med. I was worried about having him on an antipsychotic for so long hence the change in meds.
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Post by crescentcitygal on Aug 7, 2007 23:15:49 GMT -5
We had our follow-up visit today with the psych., and I described my observations of my son's behavior on the Catapres patch. He has definitely been more irritable the past couple of days. He also just doesn't seem happy. He had a meltdown yesterday while we were playing a game with his sister, and then another one last night because daddy wouldn't let him have a piece of cake before bed. I told him it was hard to tell if the medicine was making him irritable, or if the irritability was directly related to being so tired (I have noticed the irritability increases in the early afternoon, right before he wants to nap, and again right before bed time). Also, my son (age 6) has not napped since about age 3 1/2, and has been wanting to nap every day on the Catapres. He starts 1st grade at the end of the month, and he certainly can't be having these meltdowns in the middle of the day because he needs a nap.
The dr. said it is indeed hard to tell whether the irritability is a reaction to the drug itself, or if it was being caused by the tiredness. He did say that it could take a few weeks to see the full beneift of the drug, and that we very well could see the fatigue decrease and the impulse-control improve over a period of several more days to weeks. He gave me the choice of cutting the Catapres patch in half and sticking it out a few more weeks (letting his body adjust to the medication at a lower dosage), combining the Catapres with a stimulant (which had helped him in the past but brought out tics), or trying Strattera. I told him I had been wanting to ask him about Strattera and if it might be a good choice for him with his particular profile. He said that if we wanted to try Strattera, now would be the time to do it since we still have a few more weeks until school starts. So that is what we have chosen to do. If the Strattera trial doesn't work for him, I'm not sure if we will try the Catapres/stimulant combination, or just give meds a break for now.
Paula
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